NPIMap

Organization Active NPI

Altamed Health Services Corp

Doing business as AltaMed Medical and Dental Group-South Gate

  • Federally Qualified Health Center (FQHC)
  • South Gate, CA
National Provider Identifier
1902267479
Registry record updated Feb 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ALTAMED HEALTH SERVICES CORP
Doing business as
AltaMed Medical and Dental Group-South Gate
Practice address
8627 Atlantic Ave
South Gate, CA 90280-3501
Phone
(323) 312-2625
Fax
(323) 312-2984
NPI assigned
Mar 11, 2016
Last updated
Feb 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert U. Young, MD
Title
VP. Patient Financial Services
Phone
(323) 622-2429

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

8627 Atlantic Ave
South Gate, CA 90280-3501

Mailing address

2040 Camfield Ave
Los Angeles, CA 90040-1501
Phone (323) 725-8751

Other identifiers 1

IdentifierTypeStateIssuer
PTL5426OtherCAMEDICAL BOARD OF CALIFORNIA

Other names 1

  • AltaMed Medical and Dental Group-South Gate Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20170623001562 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: South Gate, CA
O20230427002857 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: Paramount, CA
O20240430004537 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: Pasadena, CA
O20240531002971 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: Pasadena, CA
O20240608000319 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: El Monte, CA

NPI to CCN mapping 5

The Medicare certification numbers (CCNs) connected to NPI 1902267479. Details of each certification follow.

Federally qualified health center certification: CCN 751974

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL AND DENTAL GROUP-SOUTH GATE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 10, 2017
Last certification
May 10, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
8627 Atlantic Ave
South Gate, CA 90280-3501

Federally qualified health center certification: CCN 921134

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP - PARAMOUNT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 25, 2023
Last certification
Apr 25, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
14906 Paramount Blvd
Paramount, CA 90723-3409

Federally qualified health center certification: CCN A01854

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED GENERAL PEDIATRICS AND DENTAL GROUP-PASADENA, LINCOLN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 15, 2024
Last certification
Apr 15, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
2055 Lincoln Ave
Pasadena, CA 91103-1324

Federally qualified health center certification: CCN A01861

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL AND DENTAL GROUP - PASADENA, FAIR OAKS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 16, 2024
Last certification
May 16, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
1855 N Fair Oaks Ave
Pasadena, CA 91103-1620

Federally qualified health center certification: CCN A01856

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL AND DENTAL GROUP-EL MONTE, PECK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 11, 2024
Last certification
Apr 11, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
3703 Peck Rd
El Monte, CA 91731-3543

Other NPIs with the same Medicare PAC ID 22

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 22

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0937817Altamed Medical and Dental Group1855 N Fair Oaks Ave Ste 200, Pasadena, CA 91103Certificate of waiverSep 30, 2026
05D2127025Altamed Medical and Dental Group8627 Atlantic Ave, South Gate, CA 90280Provider-performed microscopySep 9, 2027
05D2296364Altamed Medical Group - El Monte Peck3703 Peck Rd Ste C, El Monte, CA 91731Certificate of waiverDec 26, 2027
05D2296368Altamed Pediatrics and2055 Lincoln Ave, Pasadena, CA 91103Certificate of waiverDec 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Altamed Health Ser117 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Maria Grimaldo Individual Corporate DirectorConsumer Board Member Oct 29, 2013
Corporate DirectorBoard Member Oct 29, 2013
Jose Avalos Individual Corporate DirectorBoard Chairman Jun 28, 2018
Corporate DirectorBoard Chair Jun 28, 2018
Corporate DirectorChair, Board Member Jun 28, 2018
Adolfo O Chanez Individual Corporate DirectorBoard Member Feb 25, 2016
Castulo de la Rocha Individual Corporate OfficerPresident & Ceo Mar 1, 1977
Corporate OfficerPresident and Ceo Mar 1, 1997
Marc Victor Individual Corporate DirectorBoard Treasurer Oct 26, 2017
Corporate DirectorTreasurer Oct 26, 2017
Corporate DirectorBoard Member Oct 26, 2017
Ricardo Robles Individual Corporate DirectorBoard Vice Chairman Jan 22, 2015
Corporate DirectorVice Chair Jan 22, 2015
Corporate DirectorSecretary, Consumer Board Member Jan 22, 2015
Victor Olmos Individual Corporate DirectorBoard Member Oct 23, 2020
Corporate DirectorTreasurer, Board Member Oct 23, 2020
Joseph Gomez Individual Corporate Director Sep 6, 2019
Corporate DirectorBoard Member Sep 6, 2019
Corporate DirectorConsumer Board Member Sep 6, 2019
Jose Ubaldo Esparza Individual Corporate OfficerExecutive VP of Finance & Cfo Jan 20, 1994
Corporate OfficerEvp, Finance and Cfo Jan 20, 1994
Corporate OfficerEvp, Finance and Cfo Jan 6, 2012
Robert Young Individual W-2 Managing EmployeeVP, Patient Financial Services Jan 5, 2009
W-2 Managing EmployeeVice President, PFS Jan 6, 2012
Nadia Paola Alvarez Individual Corporate DirectorConsumer Board Member Sep 6, 2019
Corporate DirectorBoard Member Sep 6, 2019
Lucy Maria Herrera Individual Corporate DirectorBoard Secretary Oct 25, 2019
Corporate DirectorSecretary Nov 5, 2019
Corporate DirectorVice Chair, Consumer Board Member Nov 5, 2019
Maria Cervantes Individual Corporate DirectorBoard Member Jun 28, 2018

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644192000000",
    "number": "1902267479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 CAMFIELD AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900401501",
            "telephone_number": "323-725-8751",
            "fax_number": "323-889-7399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8627 ATLANTIC AVE",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902803501",
            "telephone_number": "323-312-2625",
            "fax_number": "323-312-2984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTAMED HEALTH SERVICES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-11",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "U.",
        "authorized_official_title_or_position": "VP. PATIENT FINANCIAL SERVICES",
        "authorized_official_telephone_number": "323-622-2429",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL BOARD OF CALIFORNIA",
            "identifier": "PTL5426",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AltaMed Medical and Dental Group-South Gate",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AltaMed Medical and Dental Group-South Gate",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Gate, CA

Sources for this page

Verify at the official NPI Registry.